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Tensions mount over NICE skin cancer surgery guidance

NICE has admitted it may need to rewrite its advice on minor surgery for skin cancers if dermatologists and GP leaders cannot reach agreement in an upcoming meeting.

After three years of intense lobbying by GPs, the institute has been forced to schedule a meeting next month between the RCGP and GPC on one side and the British Association of Dermatologists on the other.

The move comes after controversy over PCTs clamping down on the removal of basal cell carcinomas in general practice, which GPs argue effectively prevents them from performing minor skin surgery.

In October, Pulse revealed the behind-the-scenes war of words between the GPC and NICE, with GPC chair Dr Laurence Buckman claiming many trusts were implementing the institute's guidance in a ‘draconian' manner, and at least one had abandoned it as ‘unworkable'.

The GPC demanded that ‘serious consideration is given to withdrawing the guidance and then republishing after the full implications within primary care have been evaluated'.

A statement from NICE last week said: ‘We have become aware of concerns, particularly from GPs, about some of the recommendations around GP minor surgery and how it is being interpreted and implemented to limit their role.'

Dr Fergus Macbeth, director of the NICE guidelines team, told Pulse: ‘There have been discussions between myself, NICE chief executive Andrew Dillon and Dr Buckman, and clearly the response was not satisfactory.

‘I hope we can resolve things through the meeting and avoid having to rework the guidance, as that will be quite an elaborate procedure,' he said.

‘But if the outcome of the meeting is that the guidance needs to be looked at and further revisions made that would need to be considered by the NICE executive committee.'

Professor Steve Field, chair of the RCGP, said: ‘It's essential we have clearer, more detailed guidance for GPs.

‘We hope that by producing some clear guidance we can help GPs to continue performing minor surgery – otherwise secondary care will drown in referrals.'

But the British Association of Dermatologists, which Pulse revealed in December had urged the Department of Health to clamp down on GP minor surgery, was bullish.

It insisted it would not attend the meeting merely to ‘rubber stamp the continued involvement of practitioners who do not demonstrate appropriate skills and outcomes in the management of skin cancer'.